One hundred and twenty one people died in mountaineering accidents in Scotland between July 1978 and December 1983. Necropsies were carried out on 42, which form the basis of this report. In 21 cases head injury was major fatality factor, but in 11 of these there were also serious chest injuries. Focal brain damage (haematomas, contusions, or lacerations) was more common (n = 21) than diffuse brain damage (n = 18). Over half of the victims with severe head injury had few other injuries and would probably have survived had the head injury been prevented. Spinal injuries usually occurred with other major injuries. Chest injuries were common, being serious in 18 cases, but abdominal injuries were uncommon. Four climbers with only minor injuries died of hypothermia.